The Israel National Institute for Health Policy Research In collaboration with The Israel National Council for the Rehabilitation in the Community of Persons with Mental Disabilities International Workshop Rehabilitation and Community Integration of Persons with Psychiatric Disabilities: The First Ten Years and Beyond October 13-14, 2010 | Caesarea | Israel The Israel National Institute for Health Policy Research In collaboration with The Israel National Council for the Rehabilitation in the Community of Persons with Mental Disabilities Rehabilitation and Community Integration of Persons with Psychiatric Disabilities: The First Ten Years and Beyond International Workshop Report Editor: Uri Aviram October 2010, Caesarea, Israel Rehabilitation and Community Integration of Persons with Psychiatric Disabilities 3 Table of Contents Page 1. Forewords 5 Tamar Gozansky 7 Shlomo Mor-Yosef 9 Ronni Gamzu 10 Gad Lubin 11 2. Introduction 13 Rehabilitation and Community Integration of Persons with Psychiatric Disabilities: The First Ten Years and Beyond Uri Aviram 15 3. Abstracts 23 4. Presentations 37 The Rehabilitation in the Community of Persons with Mental Disabilities Law of Israel: Challenge and Opportunity in a Changing Mental Health Service System Uri Aviram 39 Rehabilitation of Persons with Mental Disabilities in Israel Yechiel Shereshevsky 55 Integrating Services for Recovery: Lessons from the American Experience Michael F. Hogan 60 Integrating Rehabilitation Services for Persons with Psychiatric Disabilities with the Mental Health, Health, and Welfare Systems: Lessons from the Experience in England Graham Thornicroft 75 4 International Workshop Psychiatric Rehabilitation and Recovery Robert E. Drake 87 Understanding and Supporting Personal Recovery Mike Slade 94 5. Appendices 103 a. Workshop Program 105 b. The Rehabilitation of the Mentally Disabled in the Community Law (2000) 107 c. List of Speakers and Chairpersons 119 d. Biographies of the Speakers and Chairpersons 120 e. Steering Committee 128 f. List of Participants 129 Rehabilitation and Community Integration of Persons with Psychiatric Disabilities 5 Forewords Rehabilitation and Community Integration of Persons with Psychiatric Disabilities 7 Honored audience, I would like to begin by thanking you for your willingness to study the impact and effects of the “Rehabilitation of the Mentally Disabled in the Community Law.” The legislative process that brought about this law was long and arduous; in fact it took three years. At this opportunity, I would like to once again thank all those who helped put the law together, overcome the obstacles, and especially, enabling the inclusion of a detailed services' package. The Basic Law on Human Dignity and Liberty is mentioned in the law's preamble, and not as pure ornamentation. My starting point, and that of many who helped me, was the concern for the liberty and dignity of the mentally disabled. But a right, if it is not to remain solely on paper, must be supplemented with an obligation on the part of society, of the state, and of the government, to protect, through true integration, budget allocations, and buildings, the right of the mentally disabled to live among us, and as much as possible, like us. An important goal of the law was to respond to the unique characteristics of the mentally disabled, which have prevented them from receiving proper attention to their needs vis-à-vis the services provided to other disabled and handicapped persons by the Ministry of Welfare. In forming the law so as to address this uniqueness, we were immensely helped by the Ministry of Health, and in particular by the Rehabilitation Office headed by Yechiel Shereshevsky. The decade that has passed since passage of the law has proven the accuracy of the basic assumption underlying the law: that rehabilitation of the mentally disabled is a social and moral duty of society struggling against discrimination and promoting equality. It also proves that a social and moral act can be economically viable, as it enables us to transfer funds out of the hospitalization sector for utilization in integration into the work-force and living in the community. * Greetings at the opening session of the International Workshop, Rehabilitation and Community Integration of Persons with Psychiatric Disabilities: The First Ten Years and Beyond, The Israel National Institute for Health Policy Research, October 13-14, 2010, Caesarea, Israel. 8 International Workshop The social and individual impact of the law are a result of the dedicated work and energy of all of those involved in community rehabilitation of the mentally disabled. You, working in the field of rehabilitation, have proven that the law is not wishful thinking, but rather a practical way of rehabilitating the disabled; improving their quality of life and realizing their right to be an integral part of the community. The rehabilitation of tens of thousands of mentally disabled over the last decade is a great achievement, but one that does not guarantee that the law will not once again be put in danger. My wish for the mentally disabled and their families, for the rehabilitating organizations, for the therapeutic teams and for the Ministry of Health, is that through collaborative action you will manage not only to prevent any attempts to make cuts in the existing law, but also to extend the services’ package, so that more and more groups of mentally disabled will be included within its coverage. All that we ask is to liberate ourselves from prejudice and provide each and every human being with a real chance to live in dignity. Tamar Gozansky Former member of Knesset Rehabilitation and Community Integration of Persons with Psychiatric Disabilities 9 Dear Colleagues In July 2000, Israel’s Knesset legislated the “Rehabilitation in the Community of Persons with Mental Disabilities Law” (RMD). This important legislation was expected to have a significant and direct impact on the health, rehabilitation, and welfare of individuals suffering from limitations resulting from psychiatric disorders. One of the goals of RMD is the transfer of full responsibility for mental health services to the health funds, which has not yet been accomplished, and as a result remains the responsibility of the Government. It is well known that mental health issues have many ramifications on physical well-being and are therefore appropriately an integral part of the health services system. The mental health system functions as an integrated system with the general health system, and as a result RMD and other reforms that followed have had direct consequence on both the mental health ambulatory and hospitalization systems, as well as on the general health system. In accordance with its mission to research and advance issues related to the 1995 National Health Insurance Law, of which RMD is an extension, the Israel National Institute for Health Policy Research saw fit to mark the 10th anniversary of RMD’s passing by organizing an international workshop to discuss and evaluate RMD’s implementation and review plans for the future. “The Rehabilitation and Community Integration of Persons with Psychiatric Disabilities: The First Ten Years and Beyond” International Workshop was expertly organized and chaired by Prof. Uri Aviram in cooperation with the Israel National Council for the Rehabilitation in the Community of Persons with Mental Disabilities. We believe that it is important to learn from the experience of others; to deliberate with international experts on topics facing the system; and determine how we can improve the service. Four senior experts in the field, two from Britain and two from the US, accepted our invitation to participate in the Workshop. Approximately 50 policy makers, researchers and leading authorities in the field of mental health rehabilitation participated in the Workshop during the two very fruitful days of deliberations. It is my hope that this book, which summarizes the Workshop’s proceedings, will enrich our understanding of the issues and contribute to the improvement of both mental health services and other health services in general. Sincerely, Prof. Shlomo Mor-Yosef Chairman, Israel National Institute for Health Policy Research 10 International Workshop My dear rehabilitation professionals, I welcome your initiative to document the outcomes of the workshop on expanding the rehabilitation aid offered to people struggling with mental illness. It is a highly symbolic and meaningful coincidence that at exactly the same time as your workshop and not far away geographically, the senior management of the Ministry of Health were meeting to compile a list of the Ministry's 'guiding stars' , the multi-year, continually renewing agenda of objectives and tasks the Ministry sets itself. To reinforce public medicine and reduce healthcare inequalities was one of those 'guiding stars' fixed on at our meeting. Thus these two planning for a simultaneously raised the flag of paying attention to population groups too little listened to, population groups who will be served only by a committed orientation to values and not by obedience to 'market forces'. Further, I set down here my own profound personal commitment to continue working to reinforce the capacities and resources of the mental health rehabilitation system. I salute your public-spirited work and draw inspiration from it. With my warmest wishes for your continued success, Prof. Ronni Gamzu Director General Israel Ministry of Health Rehabilitation and Community Integration of